Abstract
Context:
In India fishing is a traditional occupation second only to agriculture. Fishermen are a marginalized group with high levels of occupational stress predisposing them to develop addictions to tobacco, alcohol, and areca nut chewing. These habits are well-established causes of developing oral potentially malignant disorders and oral cancer.
Aims:
To determine the prevalence of oral potentially malignant disorders among the fishermen population in and around Pondicherry.
Settings and Design:
Cross-sectional study.
Methods and Material:
A descriptive cross-sectional study was conducted using a pre-designed and pre-tested questionnaire to assess the prevalence of oral potentially malignant disorders among the fishermen population in and around Pondicherry.
Statistical Analysis Used:
Descriptive statistics were used with Pearson's correlation.
Results:
The study showed 24.8% of fishermen consumed tobacco, and 7.3% consumed both tobacco and alcohol. Oral potentially malignant disorders were seen in 16.79% of the population.
Conclusions:
The fishermen had a higher rate of addictions to tobacco, alcohol, and areca nut chewing and a higher prevalence of oral potentially malignant disorders.
Keywords: Fishermen, occupational stress, oral precancerous conditions
INTRODUCTION
Fishing is an ancient occupation of the inhabitants of the coastal regions of the country. A fisherman are a special group of people with some unfavorable lifestyles making them vulnerable to various habits.[1] India is the second largest fish-producing country in the world and contributes over 5% to the agricultural GDP[2] and export earnings from fisheries were 46,6625.85 crores during 2019-2020.[3]
Due to job-related stress, there is extensive use of tobacco in various forms like smoking, chewing, and pan masala together with alcohol consumption, making the population belonging to this occupation more vulnerable to oral cancer.[1]
The majority of oral cancers are preceded by alteration in the oral mucosa known as oral potentially malignant disorders (OPMD). In the coastal belt of India, the use of tobacco and areca nut, either alone or in combination, accounts for the vast majority of oral potentially malignant disorders (OPMD) and oral cancers.[4]
With this background this study aimed at assessing the prevalence of OPMDs among the fishermen population in and around Pondicherry. Pondicherry is a coastal area in South India along the Bay of Bengal where sea fishing is the chief occupation.
SUBJECTS AND METHODS
This prevalence study was conducted after obtaining clearance from the Institutional Ethical board. This study was conducted from January 2020 to June 2021 among the fisherman population in and around Pondicherry. The list of fishing villages and the number of fishermen engaged in marine fishing were obtained from the Ministry of Fisheries, Pondicherry. Marine fishermen above the age of 18 years were included in the study and those aged below 18 years were excluded from the study. Based on the initial pilot study data the estimated sample size was 262. A survey of the study area was carried out with the help of a Medical Social Worker and volunteers from a private dental college at Pondicherry. A pre-validated self-administered questionnaire was used for data collection and was developed after extensive content-setting interviews with fishermen by oral diagnosis specialists, and medical social workers. The questionnaire explored a range of health and dietary issues, use of various tobacco products, and alcohol consumption. Written informed consent was obtained from participating subjects.
The training of examiners was done in the department of Oral Medicine and Radiology. Only males involved with long voyages were included in the study. The subjects were explained about the study and consent was obtained. The screening and the oral health status were recorded using American Dental Association (ADA) type 3 examination which includes observation and examination of the oral cavity under adequate illumination. The data was collected in World Health Organization proforma (2013) which is a standardized proforma for oral health assessment in adults. Following the oral examination, the participants were provided with oral health education. The subjects who were clinically diagnosed to have OPMD were further confirmed with a biopsy and suitably management. Periodic follow-up were done. The obtained data was subjected to further statistical analysis.
RESULTS
Data were pooled and coded in the Microsoft Excel spreadsheet. Epi-Info statistical software (version 7.2) was used to analyze the data. Descriptive statistics were shown in terms of frequency and percentages. Continuous data were represented in the form of mean and standard deviation and the association between variables was calculated using the Pearson correlation test where a P value of less than 0.05 was considered significant. The study had a 100% male population (n = 262) with the mean age of participants being 42.43 ± 15.344 years. Considering the habits 49.3% (n = 115) who had been fishing for a mean of 20.34 ± 13.9 years in our study sample had no reported habits. Habits of smoking or chewing tobacco were noted in 24.8% (n-65) [DOF = 23.54 ± 12.356 years] whilst habit of alcohol consumption was noted in 24.0% (n-63) [DOF = 21.90 ± 13.27 years]. The distribution of habits among the study population is shown in Table 1. Oral potentially malignant disorders (OPMDs) were seen in 16.79% (n = 44) of our study population whilst 81% (n = 218) had no detectable OPMDs (NO OPMDs). Further, the variant of OPMDs along with their percentages are shown in Table 2. The duration of fishing (DOF) had a significant correlation with the mean age of the subjects (p = 0.0005).
Table 1:
Distribution of habits among study population
| Habits | Frequency | Percentage (%) |
|---|---|---|
| No habits of tobacco or alcohol | 115 | 43.9 |
| Smoking or chewing tobacco | 65 | 24.8 |
| Alcohol consumption | 63 | 24.0 |
| Both tobacco and alcohol | 19 | 7.3 |
| Total | 262 | 100.0 |
Table 2:
Distribution and variant of OPMDs among study population
| Provisional Diagnosis | Frequency | Percentage (%) |
|---|---|---|
| No PMDs vs PMDs: | ||
| NO OPMD | 212 | 80.9 |
| 0PMDs | 50 | 19.1 |
| Total | 262 | 100.0 |
| Variants of PMDs: | ||
| Pre-Leukoplakia | 9 | 3.4 |
| Leukoplakia | 22 | 8.4 |
| Oral Submucous Fibrosis | 3 | 1.1 |
| Erythroplakia | 1 | 0.4 |
| Erosive lichen Planus | 8 | 3.1 |
| Pre-leukoplakia and Erythroplakia | 1 | 0.4 |
DISCUSSION
A community-based descriptive epidemiological study on various harmful substance addictions along with variables associated with it among fishermen in the Southern-East Costal area of Mumbai observed a 63.4% relative use of tobacco among fishermen.[5] The authors found that alcohol and tobacco consumption were significantly associated with age, type of job, job stress, job satisfaction, and duration of fishing.
Among the fishermen tobacco consumption in both forms (smoking or smokeless) was noted in 24.8% whilst habit of alcohol consumption was noted in 24%. Both tobacco and alcohol consumption was observed in 7.3%. The results of the present study were similar to the study carried out to assess the prevalence of tobacco and alcohol consumption among fishermen of Udupi Taluk, Karnataka, India,[6] however another study was done to compare the use of tobacco among fishermen and non-fishermen concluded that 22% of fishermen consumed some form of tobacco compared to 8% of non-fishermen.[7]
Oral cancer is mainly attributed to the use of chewing betel quid with tobacco and could be preceded by clinically evident oral potentially malignant disorders (OPMDs). Oral Leukoplakia, erythroplakia, and oral submucous fibrosis (OSMF) are the most common oral potentially malignant disorders.[8] An Indian study reported the prevalence of OPMD was 13.3% to 13.9% among which oral leukoplakia was reported in 36.7%, OSMF in 21.4%, and erythroplakia in 9.3% of the population.[9] In the present study, the overall prevalence of OPMD was 16.79% among them pre leukoplakia was present in 3.4% of 16.79%, oral leukoplakia in 8.4% of 16.79%, OSMF in 1.1% of 16.79%, erythroplakia in 0.4% of 16.79% and erosive lichen planus in 3.4% of 16.79% of the population. The observations of the present study indicate the prevalence of OPMD among the fishermen population is high compared to the prevalence of OPMD in the general population.
A literature search revealed the present study is a pioneer study by itself, hence results of the present study are compared with the results of studies assessing information from the general population. Apart from addiction to tobacco and alcohol, poor economic status and illiteracy which can be the reason for the high prevalence of OPMD have been observed in studies conducted among fishermen along the coast of the Bay of Bengal where the present area of study is also situated.[10,11] Also fishermen predominantly consume fish and rice and very less fruits, vegetables, and other pulses. They are found to suffer from iron, beta-carotene, and calcium deficiency.[12] Iron is essential for the overall integrity and health of epithelia of the digestive tract and its contribution to normal enzymatic functions. Iron deficiency is a well-known predisposing factor for causing oral submucous fibrosis predisposing to oral cancer. Iron deficiency is a well-known predisposing factor for causing oral submucous fibrosis predisposing to oral cancer.
CONCLUSION
Fishing is a chief occupation for people living in coastal regions of our country however fishermen community is a marginalized group, they are physically isolated with little access to infrastructure and services or social policies. Fisheries are the second largest contributor to the annual GDP after agriculture, yet the fishermen communities are a marginalized group, they are physically isolated with little access to infrastructure and services or social policies. Oral health awareness programs should be implemented among the fishermen's community to educate them about the health risks associated with alcohol and tobacco consumption and the importance of oral health and early detection of oral cancer.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgement
Department of Public Health Dentistry, Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth (Deemed to be University) Pillayarkuppam, Pondicherry 607402.
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